Sir Bruce Keogh is proposing a radical transformation of accident and emergency services in England, after finding that, in its current form, the system is "creaking at the seams".
His plans involve a "system-wide transformation over the next three to five years" which, he claims, is "the only way to create a sustainable solution and ensure future generations can have peace of mind that, when the unexpected happens, the NHS will still provide a rapid, high quality and responsive service free at the point of need."
Overall, Sir Bruce is proposing a "fundamental" shift in urgent care provision, with more extensive services outside of A&E departments, leaving patients with more serious or life threatening conditions to get treated in centres geared up with the best clinical teams, expertise and equipment.
Under his two-part strategy, for people with urgent but non-life threatening needs there must be a "highly responsive, effective and personalised service" outside of hospital, which means delivering care in or as close to people’s homes.
This could help cut back on 40% of patients that turn up at A&E but need no treatment, Sir Bruce said, noting that up to one million emergency admissions were avoidable last year and up to 50% of 999 calls could be managed at the scene.
Also, his blueprint boosts the scope of NHS 111, creating a 24 hour, personalised priority contact service that will have knowledge about people’s medical problems and allow patients to speak directly to a healthcare professional if appropriate, and also calls for better information to help improve self-care.
Patients with more serious or life threatening emergency needs - such as those with heart attack or stroke - should be seen to in major emergency centres to boost their chances of survival and recovery.
"A&E departments up and down the country offer very different types and levels of service, yet they all carry the same name," Sir Bruce said. "We need to ensure that there is absolute clarity and transparency about what services different facilities offer and direct or convey patients to the service that can best treat their problem".
Emergency centres and major emergency centres
To that end, once urgent care services outside of hospital have been successfully enhanced, two types of hospital emergency department - Emergency Centres and Major Emergency Centres - will be introduced.
Emergency Centres will be capable of assessing and initiating treatment for all patients and safely transferring them when necessary, while Major Emergency Centres, of which there will be around 40-70 across the country, will be much larger units, capable of not just assessing and initiating treatment for all patients but providing a range of highly specialist services.
Sir Bruce did stress that "there is no simple solution" to the problems faced by A&E, which is seeing 50% more patients now than 10 years ago, and that different approaches will be needed across metropolitan, rural and remote areas.
According to Amanda Doyle, Co-Chair of NHS Clinical Commissioners’ Leadership Group and Chief Clinical Officer of Blackpool CCG, delivering the changes will need "a clear and consistent strategy that involves local commissioners in its development and implementation," and "a joined up conversation between the different elements of the commissioning system along with regulators and providers and certainty that the strategy will be supported by wider stakeholders".
Different approaches also needed
Commenting on the report, Jonathan Shapiro, Honorary Senior Fellow in Health Services Research, University of Birmingham, told PharmaTimes World News that the A&E crisis requires three simultaneous approaches, of which Keogh only mentions one - rationalising services them clearly and decisively.
"However, he does not explicitly mention that a major component of the problem is a crisis in way finding, in that the lay public (especially when we are anxious and ill) don’t know how to navigate the system," nor does he "address the real demand issues to begin to change society’s attitudes to illness and self-care, so that limited public services are used more appropriately".
"Prof Keogh’s 'prescription’ will help with symptom control, but won’t cure the underlying illness; for that, we will need to look more closely at the patients, and not just keep changing their hospitals," Shapiro stressed.